Illustrated techniques for performing the Cox-Maze IV procedure through a right mini-thoracotomy

Jason O. Robertson, Washington University School of Medicine in St. Louis
Lindsey L. Saint, Washington University School of Medicine in St. Louis
Jeremy E. Leidenfrost, Washington University School of Medicine in St. Louis
Ralph J. Damiano, Washington University School of Medicine in St. Louis

Abstract

The Cox-Maze IV procedure has replaced the "cut-and-sew" technique of the original Cox-Maze operation with lines of ablation created using bipolar radiofrequency (RF) and cryothermal energy devices. In select patients, this procedure can be performed through a right mini-thoracotomy. This illustrated review is the first to detail the complete steps of the Cox-Maze IV procedure performed through a right mini-thoracotomy with careful attention paid to operative anatomy and advice. Pre- and post-operative management and outcomes are also discussed. This should be a practical guide for the practicing cardiac surgeon.